<html>
<head>
<title>solicitud {Afiliado}</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<link href="adm_est.css" rel="stylesheet" type="text/css">
</head>
<body leftmargin="0" topmargin="0" OnContextMenu="return false">
<table width="786" cellspacing="0" cellspacing="0" align="left">
<tr>
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            <td></td>
        </tr>
        <tr height="24">
        	<td colspan="7"></td>
            <td colspan="7" class="normal" align="center"><i>{Comite}</i></td>
            <td colspan="2"></td>
            <td></td>
        </tr>
     	<tr><td colspan="17" height="42"></td></tr>
        <tr height="22">
        	<td colspan="4"></td>
            <td colspan="9" class="normal" align="center"><i>{Nombre}</i></td>
            <td colspan="4"></td>
        </tr>
     
        <tr height="22">
        	<td colspan="2"></td>
            <td colspan="4" class="normal" align="center"><i>{DNI}</i></td>
            <td colspan="4"></td>
            <td colspan="5" class="normal" align="left"><i>{Cargo}</i></td>
            <td colspan="2"></td>
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        <tr height="22">
        	<td colspan="4"></td>
            <td colspan="8" class="normal" align="center"><i>{Dependencia}</i></td>
            <td colspan="5"></td>
        </tr>
     	<tr><td colspan="17" height="140"></td></tr>
        <tr height="22">
        	<td colspan="3"></td>
            <td colspan="10" class="normal" align="center"><i>{Domicilio}</i></td>
            <td colspan="4"></td>
        </tr>
        <tr height="22">
        	<td></td>
            <td colspan="6" class="normal" align="center"><i>{Poblacion}</i></td>
            <td></td>
            <td colspan="2" class="normal" align="left"><i>{CP}</i></td>
            <td colspan="7" class="normal" align="left"><i>{Provincia}</i></td>
        </tr>
     	<tr><td colspan="17" height="20"></td></tr>
        <tr height="24" class="normal">
        	<td colspan="2"></td>
            <td colspan="4" align="center"><i>{ProvinciaComite}</i></td>
            <td><i>{Dia}</i></td>
            <td colspan="4" align="center"><i>{Mes}</i></td>
            <td colspan="2" align="left">&nbsp;</td>
            <td colspan="2" align="left"><i>{Hora}</i></td>
            <td colspan="2" align="left"></td>
        </tr>
     	<tr><td colspan="17" height="275">&nbsp;</td></tr>

      </table>
  </td>
</tr>

</table>
</body>
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